Provider Demographics
NPI:1821097114
Name:WILLEY, KATHLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:WILLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 YORKLYN RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-8718
Mailing Address - Country:US
Mailing Address - Phone:302-235-2351
Mailing Address - Fax:302-235-2365
Practice Address - Street 1:722 YORKLYN RD
Practice Address - Street 2:SUITE 400
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8718
Practice Address - Country:US
Practice Address - Phone:302-235-2351
Practice Address - Fax:302-235-2365
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005226207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000944501Medicaid
DE0000944501Medicaid
DE00L25Q65Medicare ID - Type Unspecified